Provider Demographics
NPI:1932416518
Name:WAKELIN, DONYELE EVYONNE (CMT)
Entity type:Individual
Prefix:
First Name:DONYELE
Middle Name:EVYONNE
Last Name:WAKELIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:DONYELE
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4343 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4324
Mailing Address - Country:US
Mailing Address - Phone:520-329-2735
Mailing Address - Fax:
Practice Address - Street 1:4343 46TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4324
Practice Address - Country:US
Practice Address - Phone:520-329-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist